VisualDx in the Republic of Congo

Monkeypox

I downloaded VisualDx when I was in residency and found it a useful tool, since it has pictures ranging from mild to worst-case scenarios, as well as in different skin tones. I am now working in Impfondo, Republic of Congo, and continue to use VisualDx. Several weeks ago, we had a young woman in her 20s with known HIV and TB present to the clinic with dysphagia (difficulty swallowing), headache, fever, and a generalized papular rash, more prominent on the extremities and face than on the torso. There have been cases of monkeypox here before, but I had never seen it. I used VisualDx to look up a differential for the patient’s rash, as well as specifically monkeypox.

Interestingly enough, the diagnostic overview of monkeypox mentioned several outbreaks in the Likouala region of the Republic of Congo, which is where I am practicing. It is common here for people to eat monkey and Gambian rat, and the patient’s family reported eating the former. We reported our suspicions to the local health department, and someone was sent to obtain a sample for testing. It came back positive for monkeypox.

Cryptococcosis

There was another patient, also HIV positive, who presented with a somewhat similar rash, but the papules were more umbilicated. VisualDx also helped in that case, as the skin lesions of cutaneous cryptococcosis and molluscum contagiosum are very similar. The pictures were great for comparison. We treated her for cutaneous cryptococcosis, and she got better.